Cognition, emotion and quality of life after subarachnoid hemorrhage.
Item
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Title
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Cognition, emotion and quality of life after subarachnoid hemorrhage.
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Identifier
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AAI3074658
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identifier
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3074658
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Creator
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Kreiter, Kurt Timothy.
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Contributor
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Adviser: Joan Borod
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Date
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2003
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Psychometrics | Psychology, Clinical | Psychology, Psychobiology
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Abstract
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Cognitive dysfunction and depression are commonly reported sequelae of subarachnoid hemorrhage (SAH) and have been attributed to specific disease factors that reflect both focal (e.g., ischemic infarction) and diffuse (e.g., global hypoxia) injuries. We sought to comprehensively evaluate: (1) the impact of focal and diffuse disease factors on 3-month cognitive and emotional outcome, and (2) the association between cognitive/emotional disturbances and quality of life (QoL).;We prospectively evaluated 3-month outcomes in 68 of 150 consecutively-admitted, non-traumatic SAH patients, with a comprehensive neuropsychological evaluation, including assessments of cognition (i.e., attention, verbal memory, language, etc.) and emotion (i.e., depression) and quality of life (QoL). Demographic and disease-specific variables were initially screened for univariate associations with cognitive and emotional outcomes in a series of analysis of variance (ANOVA) models. Disease factors with significant univariate associations were then entered into a series of forward stepwise multiple regression models, while controlling for relevant demographic factors. In separate analyses, indices of cognitive and emotional dysfunction that demonstrated significant univariate associations with Sickness Impact Profile scores were used as predictor variables in multiple linear regression models of QoL.;The proportion of subjects who scored in the impaired range (>2 SD below the normative mean) on each neuropsychological test ranged from 3 to 45 percent. Admission Hunt-Hess grade greater than 2, thick SAH in the anterior interhemispheric fissure, infarction from vasospasm, and left-sided aneurysm location were consistently associated with cognitive dysfunction in the univariate analysis. In the multivariate analysis, the presence of cerebral edema, infarction, and anterior circulation aneurysms were independent predictors of cognitive dysfunction after SAH. After controlling for demographics and premorbid cigarette use, depression was not associated with any disease factor. QoL scores were significantly associated with depression, motor performance, and verbal memory.;Cognitive dysfunction is predicted by both diffuse and focal pathology, and, along with depression, contributes to lower quality of life in patients with SAH. While treatment strategies aimed at reducing neurologic injury related to generalized brain swelling, infarction, and clot-related hemotoxicity hold the best promise for improving cognitive outcomes after SAH, aggressive treatment of depression may result in improved QoL after SAH.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
